High incidence of severe twin hemodialysis catheter infections in elderly women - Possible roles of insufficient nutrition and social support

Background: Cuffed-tunneled hemodialysis (HD) catheters are recommended as a bridging therapy until peripheral access is available, but their long-ter m use is controversial. Aim: To evaluate the complications and lifetime of twin-tunneled HD catheters and to identify parameters which could predict t heir outcome. Methods: 29 chronic HD patients (19 female and 10 male) were inserted with twin hemodialysis catheters (28 Tesio, 1 Schon Duoflow), foll owed for up to 9 months or until catheter loss, and evaluated for severe ca theter-related complications necessitating catheter removal. Since the most common severe complication was catheter-related infection, we retrospectiv ely examined whether parameters such as age, gender, duration of end-stage renal disease, delivered dose of dialysis, nutrition, diabetes and indices of social support correlate with this outcome. Results: Severe catheter inf ection requiring catheter removal occurred in 11 patients (10 female). Of t hese infected female patients, 9 were elderly (greater than or equal to 67 years) and in 6 of those, catheter infection was fatal (54% of infected cas es). At 9 months, severe catheter infection and related patient death rates were 38 and 21%, respectively. Severe catheter infection was significantly related to less social support (p < 0.005), older age, female gender, lowe r nPCR (all p < 0.05), and tended to be related to shorter end-stage renal disease duration prior to catheter insertion (p = 0.06). Conclusion: This s tudy demonstrated that twin HD catheters are associated with a high inciden ce of severe catheter-related infections which was most significantly relat ed to social-support as well as inadequate nutrition, older age and female gender. Therefore, we suggest early removal of the catheter, enhancement of social support and dietary counseling for the elderly and lonely HD patien ts using this type of catheter. Copyright (C) 2001 S. Karger AG, Basel.